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JournalofHumanKineticsvolume31/2012,5568

55

SectionIKinesiology

WholeBodyVibrationTrainingisOsteogenicattheSpinein
CollegeAgeMenandWomen

by
GiannaC.Ligouri1,ToddC.Shoepe1,HawleyC.Almstedt1
Osteoporosis is a chronic skeletal disease characterized bylow bone mass which is currently challengingthe
American health care system. Maximizing peak bone mass early in life is a costeffective method for preventing
osteoporosis.Wholebodyvibration(WBV)isanovelexercisemethodwiththepotentialtoincreasebonemass,therefore
optimizing peak bone and decreasing the risk for osteoporotic fracture. The aim of this investigation was to evaluate
changes in bone mineral density at the hip, spine, and whole body in collegeage men and women who underwent a
WBVtrainingprotocol.Activemen(n=6)andwomen(n=4),ages1822participatedintheWBVtraining;whilean
additional 14 volunteers (1 male, 13 female) served as controls. All participants completed baseline and followup
questionnaires to assess health history, physical activity, dietary intake, and menstrual history. The WBV training
program, using a Vibraflex 550, incorporated squats, stiffleg dead lifts, stationary lunges, pushup holds, bentover
rows, and jumps performed on the platform, and occurred 3 times a week, for 12 weeks. Dual energy xray
absorptiometry (Hologic Explorer, Waltham, MA, USA) was used to assess bone mineral density (BMD, g/cm2). A
twotailed,ttestidentifiedsignificantlydifferentchangesinBMDbetweentheWBVandcontrolgroupsatthelateral
spine(averagechangeof0.022vs.0.015g/cm2).TheWBVgroupexperienceda2.7%and1.0%increaseinBMDin
thelateralspineandposterioranteriorspinewhilethecontrolgroupdecreased1.9%and0.9%,respectively.Results
indicatethat12weeksofWBVtrainingwasosteogenicatthespineincollegeagemenandwomen.
KeyWords:osteoporosis,peakbonemass,bonemineraldensity,wholebodyvibration,resistancetraining

Introduction
Osteoporosis is a skeletal disease
characterized by low bone mass, resulting in an
increasedriskforfracture.Thisdiseaseisamajor
publichealthconcerncontributingannuallytoan
estimated2millionfracturescosting$17billionto
the American health care system (Burge et al.,
2007). Obtaining an optimal peak bone mass
(PBM), which is the highest potential bone
mineral density (BMD) achieved during young
adult life, is vital for preventing osteoporosis.
Peak bone mass is attained through skeletal
maturationandthusoccursinthethirddecadeof
life(Reckeretal.,1992).Ifanindividualdoesnot
reach optimal PBM, they are at greater risk for

osteoporoticinduced fracture. However, research


showsthata35%increaseinbonemassretained
though adulthood may decrease future fracture
risk by 2030% (Wasnich and Miller, 2000).
Becauselifestylefactorssuchasdietandexercise
have been shown to influence bone mass values
by up to 40%, it is important to explore various
exercise modalities to determine effective
methodsofattainingoptimalPBM(Pococketal.,
1987). Healthful dietary intake, mechanical
loading,includingperformingresistancetraining,
have shown to be effective at increasing BMD in
young adults and thereby lowering risk of
osteoporosis(Kohrtetal.,2004).
Whole body vibration (WBV) is a newly
recognizedtrainingmodalitywiththepotentialto

HumanPerformanceLaboratory,DepartmentofHealthandHumanSciences,LoyolaMarymountUniversity,LosAngeles,USA.

Authorssubmittedtheircontributionofthearticletotheeditorialboard.
AcceptedforprintinginJournalofHumanKineticsvol.31/2012onMarch2012.

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WholeBodyVibrationTrainingisOsteogenicattheSpineinCollegeAgeMenandWomen

increase strength, reverse sarcopenia, and


improve bone mineral density (Niewiadomski et
al., 2005; Rittweger, 2010). Whole body vibration
utilizesthephysicalmechanicsofenergytransfer
throughvibrationtoprovokemusclecontractions
when standing on the active platform. Cycles of
muscle contraction and relaxation correspond to
the frequency of the vibrating platform
(Rittweger,2010).Whiletherearevarioustypesof
energy transfer provided by different types of
WBV platforms, the platform utilized in this
studyoperatesusingasidealternatingorteeter
totter fashion (Rittweger, 2010). This method
employs sinusoidal oscillations, which cause the
platform to alternate over a center fulcrum in a
steady wavelike motion, sending consistent
vibrationsthroughthemusculature.
Recent experimental research has
suggested WBV can improve strength of both
muscle and bone (Niewiadomski et al., 2005;
Verschueren et al., 2004). Jacobs and Burns
observed an acute increase in flexibility and
torque in lowerextremity musculature of male
and female participants who stood on a WBV
platformforsixminutes(JacobsandBurns,2009).
Hong and colleagues reported an increase in
muscular performance at the shoulder joint after
acute exposure to vibration via hand placement
whileholdingapushuppositionontheplatform
(Hong et al., 2010). Other muscular benefits of
WBVwereobservedbyMcBrideetal.(2010),who
reported a shortterm increase in muscle force
output following a whole body vibration and
static squat program. Improvements in bone
health with WBV training were observed by
Gilsanz et al. (2006) who reported an increase in
trabecular bone mineral density of the spine and
cortical bone area of the femur in young women
with a history of fracture and low BMD. These
results were observed after the participants
underwent a 12month WBV protocol that
consistedofstandingontheplatformvibratingat
30 Hz for 10 minutes daily. A similar study by
Beck et al. (2006) reported a 2% increase in BMD
at the nondominant hip in premenopausal
women completingaWBV programrequiring10
minutesofvibrationexposure,2timesperdayfor
12 months. These findings suggest that WBV is
effectivewhentheparticipantsstandstaticonthe
platform. However, little research has been done
ontheosteogenicbenefitsofWBVinconjunction

JournalofHumanKineticsvolume31/2012

with dynamic exercises. Because weightbearing


exerciseimprovesBMDinasitespecificmanner,
it is important to consider a specific, dynamic
program that targets the bone tissue at clinically
relevantsitessuchasthehipandspine.Previous
workhasshownsquatanddeadliftexercisestobe
osteogenic specifically at the spine (Almstedt et
al., 2011). Therefore, the purpose of this
investigation was to evaluate the osteogenic
potential of WBV training with dynamic exercise
at improving bone health in young individuals,
therebyoptimizingpeakbonemassdevelopment
andloweringfutureriskforosteoporosis.

Methods

Activecollegeagemenandwomenwere
recruited for a bone study in September and
Octoberofthefallsemester.Volunteersfromthis
group were invited to participate in a 12week
WBVtrainingprogramdesignedtoimproveBMD
or serve as controls. WBV training began in
January and continued for 12 weeks with
followinguptestingtakingplaceinthefirstweek
of May. Baseline testing occurred in
September/October and followup testing took
placeinMayimmediatelyafter12weeksofWBV
training. There was an average of 29 weeks
betweenassessments,withtheinterventiontaking
place in the final 12 weeks. The exercise
intervention consisted of sessions lasting 2030
minutes which were performed at a vibration
frequency range of 1526 Hz, 3 days per week.
Both WBV participants and controls completed
questionnairestoassessphysicalactivity,calcium
intake, and menstrual history. Dual energy xray
absorptiometry (DXA) was used to measure the
dependent variable, BMD (g/cm2) of the hip,
spine,andwholebody.ChangeinBMDbetween
the independent variable assignment of WBV
training or no training (controls) was analyzed
usingattest.
Participants
Twentyfiveactive,collegeagemen(n=7)
andwomen(n=18)volunteeredtoparticipateina
whole body vibration training program or serve
ascontrols.Ofthese,14werecontrolparticipants
(1 male, 13 females) who were asked to continue
their normal diet and exercise patterns
throughouttheperiodofstudy.Theremaining11
participants(6males,5females)underwenta12
weekwholebodyvibrationtrainingprogram.

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byLigouriG.C.etal.

Table1
ParticipantCharacteristicsatBaseline
WBV

Controls

Sex

6males,4females

1male,13females

Age(years)

19.31.3

19.81.1

BodyHeight(cm)

174.510.3

169.16.5

BodyMass(kg)

60.88.0

60.88.8

BMI(kg/m )

19.91.1

21.32.8

BodyFat(%)

17.36.5

26.64.2*

LeanBodyMass(kg)

47.38.7*

41.55.15

CalciumIntake(mg/day)

1006330

1009298

PhysicalActivity(METhrs/wk)

106.869.1

65.449.4

*significantlydifferentbetweengroups(p<0.05)
Valuesarepresentedinmeansstandarddeviations
WBV=wholebodyvibrationparticipants

Allparticipantswerebetweentheagesof18and
22 and had similar activity levelsandbody mass
index.Volunteershadnocurrentmusculoskeletal
injuries and no prior exposure to WBV.
Unfortunately, one female WBV participant
dropped out of the training program due to a
lower leg injury, which occurred outside the
training program, therefore her data is not
includedintheanalysis.Table1showsthemeans
and standard deviations for the demographic
characteristicsoftheparticipantsatbaseline.
The WBV and control groups were
similar in age, BMI, calcium intake, and physical
activity; however, the WBV participants had a
significantlylowerpercentbodyfatandagreater
lean body mass. Before commencing the training
program, all WBV volunteers and controls were
informedaboutthepotentialrisksofparticipation
and written approval was obtained from
participants. The protocol explained here was
approved by the Loyola Marymount University
Institutional Review Board for Human Subjects
Research.
Procedures
Bodyheightincmwasdeterminedbyuse
ofastadiometer(SecaAccuHite,Columbia,MD)
and body mass was measured in kg on an
electronicscale(TanitaBWB627A,Tokyo,Japan).

BMI was then calculated using this data by


dividing body mass in kg by the square of the
heightinmeters.Selfadministeredquestionnaires
were completed by all participants under the
supervision of a research assistant to determine
multiple variables such as physical activity,
calcium intake, and menstrual function.
Questionnaires were administered before
beginning the WBV training program to
determine baseline data. Testing was repeated
again after completion of the 12week training
program.TheAerobicCenterLongitudinalStudy
Physical Activity Questionnaire was used to
assess participants intensity and duration of
exerciseinmetabolicequivalents(METhoursper
week)byusingage,bodymass,hoursperweekof
physical activity, and intensity of activity. This
questionnairehaspreviouslybeenvalidatedwith
this population (Pereira et al., 1997). The Block
2005
Food
Frequency
Questionnaire
(NutritionQuest, Berkeley, CA), which evaluates
foodandnutrientintakeinthepreviousyear,was
used to assess participants baseline calcium
intake. At the end of the study period,
participants completed the LMU Rapid
Assessment Method Questionnaire (LMU RAM)
designed to evaluate daily calcium intake for the
past7days.Bothmethodsofcalciumassessment

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WholeBodyVibrationTrainingisOsteogenicattheSpineinCollegeAgeMenandWomen

are valid and have been deemed reliable for this


population (Block et al., 1990; Henry and
Almstedt,2009).Allfemaleparticipantsdescribed
theirmenstrualhistoryfortheprevious3months
andreportedanyuseofhormonalcontraceptives
inthemenstrualhistoryquestionnaire.
WholeBodyVibrationTrainingProgram

The optimal amplitude, frequency, and


durationofvibrationexposureforbonehealthare
yettobeclearlydefined(TotsydeZepetneketal.,
2009). The training program was designed with
the objective of increasing BMD and therefore
weightbearing
exercises
were
selected
specifically with this goal in mind. Training was
performed on a Vibraflex 550 (also called the
Galileo 2000, Novotec, Pforzheim, Germany)
which utilizes a sidetoside displacement
mimicking a teetertotter motion based around
a center fulcrum (Figure 1). The parameters
selected here were based on previous research
involving a similar WBV platform which was
found to be effective for eliciting a muscular,
hormonal, or bone response (Ambrecht et al.,
2010;CardinaleandBosco,2003;Gusietal.,2006;
Iwamoto et al., 2005; Russo et al., 2003). The
progressive overload principal was incorporated,
creating a nonlinear periodized program that
provided for fluctuations in volume, intensity,
andexercisecomplexityoverthetrainingperiod.
WBVparticipantscompleted12weeksoftraining,
3 times per week under the close supervision of
trained research assistants. Each workout session
lasted 2030 minutes and included one minute
rest period between each exercise set. Before
beginning the WBV protocol, a safety orientation
was held to familiarize the participants with the
correct exercise form. In order to minimize the
displacement of the head during exercise,
participants were instructed to avoid lockedout
joint positions at all times by maintaining slight
(~5)flexionoftheankles,knees,elbows,andhips
during static set (e.g. standing) and through the
concentrictoeccentrictransitionofeachdynamic
repetition. In the first two weeks, some exercises
wereperformedonthefloorwithoutvibrationin
order to develop mastery of technique and
therefore reduce the risk of injury, however only
those completed on the platform are accounted
for in Table 2. When volunteers could
demonstrate proper exercise mechanics on the
floor, they progressed to the platform. All

JournalofHumanKineticsvolume31/2012

participantshadperformedtheentireprotocolon
the platform by the sixth workout session (i.e.
second week). Volume undulated through the
duration of the program where the total number
ofsetsvariedfrom411andtotaltimeofvibration
per session varied from 165540 seconds (2.79
min). The protocol consisted of a combination of
squats,stifflegdeadlifts,stationarylunges,push
upholds,bentoverrows,andjumpsontoandoff
oftheplatform.Table2showsadetailedaccount
of the WBV program with time in seconds,
number of sets, and frequency in Hz (number of
vibration cycles per second). Participants were
asked to place their feet or hands at position 2,
marked on the platform (Figure 1A), where they
experienced a peaktopeak displacement of 4.16
mmthereforeanamplitudeof2.08mm.
In general, workout 1 of each week
incorporated squats, stiffleg dead lifts, pushup
holds, and jumps. Workout 2 of each week
included stiffleg dead lift, stationary lunges,
bentover rows, and jumps. Workout 3 was a
combination of all exercises from the previous
two workouts, but with reduced sets in order to
maintain the duration of the workout. Every
workout began with a warmup of standing on
the platform with slight flexion throughout the
lowerextremityasdescribedpreviously.Initially,
WBV squats were performed in a statically held
position at parallel thigh depth so that the
participantscouldbecomefamiliarwiththeform.
WBV squats on the platform were performed
initiallywithhandsfullygrippingthesupporting
handlebars. By week 4, all exercisers had
progressed to dynamically squatting the full
rangeofmotionwithouttheaidofthehandles.In
week 6, heel and toe raises were introduced into
the squat protocol with smooth transitions
mandatedbetweeneachsegment.Forexample,a
single repetition occurred in a cyclical fashion
whereasquatconcludednearfullextension,and
was followed immediately by a full repetition of
the heel raise exercise, which was then followed
by a toe raise prior to initiating the next squat
repetition.Inweek11,resistancebands,placedat
the level of the knee, were introduced into the
squatexercisetofurtherincreasethedifficultyby
applying additional force directed from the
valgus direction thus recruiting greater
stabilization activation of the hip abductors. The
bands were placed laterally around the femoral

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condylesandremainedtaughtastheparticipants
squattedandcompletedcalfandtoeraises.
Participants performed stiffleg deadlifts
on the platform while holding a wooden stick to
promote proper form. Initially, care was taken to
promotespinalneutralitythroughouttherangeof
motion where spinal flexion would cue the
cessationoftheeccentricphase.Bytheconclusion
ofthetraining,allparticipantshadperformedthe
exercise with at minimum hip flexion of 45, as
flexibility allowed, while maintaining spinal
neutrality.Stationarylungeswereperformedwith
thefrontfootontheplatformandthebackfooton
the ground (Figure 1B). After lunging with one
foot on the platform for the allotted time, they
changed to the other foot and repeated the
exercise to complete the set. Pushup holds were
performed both with hands on the platform and
thenfeetontheplatforminanalternatingfashion,
per set (Figures 1C and 1D). Participants would
assume a prone plank position with their arms
extended. Upon initiation of vibration, the
participantwouldflextheelbowsto90andhold
through the duration of the repetition with
minimal shoulder abduction due to the width of
the platform, while maintaining static body
positionthroughoutthecoreandlowerextremity.
Becauseofthechallengingnatureofthisexercise,
participants were allowed to decrease the
frequency based on their personal abilities
because emphasis was placed on technique in
ordertomaintainalowerriskforinjury.Pushup
holds with the hands on the platform were
frequently performed at a range 1526 Hz, based
onthestrengthoftheparticipant.Bentoverrows
wereperformedwithidenticalformtothestiffleg
deadliftwhilemovingawoodenstickthroughthe
desiredrangeofmotionwiththeupperextremity.
Emphasis was placed more on the mechanics of
the trunk rather than the movement of the arms.
In week 9, jumps onto and off of the platform
were introduced. When performing jumps
participantsstartedonthefloor,jumpedontothe
vibratingplatformandcompletedanexaggerated
eccentricphaselandingtohalfsquatdepthbefore
holding this position statically for three seconds.
Tocompleteonerepetition,theywouldthenjump
from the platform backwards off of the platform
andontothefloorandrepeatthe3secondhold.
BoneMineralDensity
Bone mineral density (g/cm2) of the hip,

lumbarspine,andwholebodywasassessedusing
dual energy xray absorptiometry (Hologic
Explorer, Waltham, MA). The spine scans allow
foranalysisofthefirstfourlumbarvertebrae(L1
L4)intheposterioranteriorviewaswellasthree
lumbar vertebrae (L2L4) in the lateral view. All
scans were performed and analyzed by the same
lab technician. The coefficient of variation
evaluating testretest reliability of DXA scans, by
this technician, at the Loyola Marymount
University Human Performance Laboratory are
1.0%forBMDofthehipandspine.
Statistics
Statistics were analyzed using SPSS
software version 17.0 (Chicago, IL, USA). To be
consideredstatisticallysignificant,thealphalevel
wassetatp0.05.Standarddescriptivestatistics
were performed on baseline data and are
presented in Table 1. Pearson correlation
coefficients were run to evaluate relationships
between baseline anthropometric variables and
BMD. Body height, body mass, BMI, nor lean
body mass were related to BMD at the spine,
howeverleanbodymasswassignificantlyrelated
to total hip BMD (r= 0.503, p< 0.05) and whole
bodyBMD(r=0.517,p<0.05).Assumptionsfort
tests were confirmed by the ShapiroWilk test
which revealed normal distributions and Levene
tests confirmed homogeneity of variances for
changes in BMD. A twotailed ttest was then
usedtoevaluatedifferencesinthechangeinBMD
at the hip, spine, and whole body between the
controlgroupandWBVgroup.

Results
ParticipantsintheWBVgroupadheredto
90% of the 12week training program (range 74
100%)withonlyonefemaleparticipantdropping
out due to an unrelated injury, as stated
previouslyinthemethods.Changesinleanbody
mass over the 12 weeks were not significantly
differentbetweengroups.TheWBVgroupgained
an average of 0.28+1.2 kg of lean mass while the
controlgrouplostanaverageof0.49+1.8kg.Lean
bodymassmayexplain2128%ofthevariationin
BMD in premenopausal women and 1873% of
variationinBMDinathleticmen(Luetal.,2009;
Rector et al., 2009). Because lean body mass has
beenreportedtoberelatedtoBMDandbecauseit
was significantly different between groups at
baseline,weevaluateditspotentialasacovariant
inthestatisticalapproachusedhere.

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WholeBodyVibrationTrainingisOsteogenicattheSpineinCollegeAgeMenandWomen

Table2
WholeBodyVibrationTrainingProgram

Week1
Day1
Day2
Day3
Week2
Day1
Day2
Day3
Week3
Day1
Day2
Day3
Week4
Day1
Day2
Day3
Week5
Day1
Day2
Day3
Week6*
Day1
Day2
Day3
Week7
Day1
Day2
Day3
Week8
Day1
Day2
Day3
Week9
Day1
Day2
Day3
Week10
Day1
Day2
Day3
Week11
Day1
Day2
Day3
Week12
Day1
Day2
Day3

Standing

Squat

Deadlift

BentOver
Jumps
Row
Sec Sets Hz Sec Sets Hz Sec Sets Hz Sec Sets Hz Sec Sets Hz Sec Sets Hz Sec Sets Hz

30 3
15 30 2
15 30 2
15
30 3
20 30 2
15
15 1
15
30 3
25 30 2
20 30 2
15 30 2
15 15 2
15
30
45
45

3
3
3

25
25
25

30
30
30

3
3
2

20
20
25

30
30
30

2
2
2

20
20
20

45
60
60

3
3
3

25
25
25

60

25

60

25

30
30
45

3
3
2

60
60
60

3
3
3

25
25
25

60

25

60

25

30
60
60

60
60
60

3
3
3

25
25
25

60

25

60

25

60
60
60

2
2
2

26
26
26

60

25

60

25

60
60
60

1
1
1

26
26
26

60

25

60

26

60
60
60

1
1
1

26
26
26

60

26

60

26

60
60
60

1
1
1

26
26
26

60

26

60

26

60
60
60

1
1
1

26
26
26

60

26

60

26

60
60
60

1
1
1

26
26
26

60

26

60

26

60
60
60

1
1
1

26
26
26

60

26

60

26

Lunge

30

15

30

20

25
25
25

60
60

3
4

25
25

3
3
2

25
25
25

60
60

2
2

25
25

60
60
60

3
3
3

25
25
25

60
60

3
2

25
25

60
60
60

4
4
2

25
25
25

60
60

3
1

25
25

60
60
60

5
5
2

25
25
25

60
60

3
1

25
25

60
60
60

5
5
2

25
25
25

60
60

3
1

25
25

60
60
60

5
2
2

25
26
26

60
60

3
1

25
25

60
60
60

5
2
2

26
26
26

60
60

2
1

26
26

60
60
60

5
2
2

26
26
26

60
60

2
1

26
26

60
60
60

5
2
2

26
26
26

60
60

2
1

26
26

PushUpHold

15
15
15

2
2
2

15
15
20

15
15

3
3

25
25

30
30

2
2

25
25

30

25

30

25

30

25

30

25

30

25

30

25

30

25

30

25

30

25

30

25

30

25

30

26

30

26

30

26

30

26

30
30

1
2

25
25

30

25

60
60

3
1

25
25

60
60

4
4

25
25

60

25

60
60

3
2

25
25

10
10

2
3

15
15

60
60

3
2

26
26

10
10
10

2
2
2

20
25
25

60
60

3
2

26
26

10
10
10

2
2
2

25
25
26

60
60

3
2

26
26

10
10
10

3
3
3

26
26
26

Sec=second;Rep=repetition;Hz=hertz
*incorporatecalfandtoeraisesintotheexercises;incorporatetheuseofbandsaroundtheknees

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byLigouriG.C.etal.

Table3
BoneMineralDensityResults
BMDSite
(g/cm2)

WBVGroup(n=10)

Baseline

12weeks

ControlGroup(n=14)

Change

Baseline

12weeks

Change pvalue

PASpineL14
BMD

0.9190.084 0.9280.089

0.009

0.9760.075

0.9670.074

0.009

0.079

LateralSpine
L24BMD*

0.8250.060 0.8350.082

0.022

0.7870.071

0.7760.068

0.015

0.031*

TotalHip
BMD

1.0240.114 1.0150.109

0.008

0.9810.064

0.9770.071

0.005

0.666

WholeBody
BMD

1.1230.085 1.1240.086

0.001

1.1190.058

1.1230.060

0.005

0.618

BMD=bonemineraldensitying/cm2;WBV=wholebodyvibration;
PA=posterioranterior;L14=lumbarvertebrae14;L24=lumbarvertebrae24
*significantlydifferentbetweengroups(p<0.05)

However, a twotailed analysis of


covariance (ANCOVA) revealed identical
findings to the ttest and results did not vary
whether or not lean body mass was controlled,
thereforeresultsofthettestarepresented.
Table 3 shows the average BMD values
and standard deviations of WBV and control
participantsatbaselineandatthe12weekfollow
up for the posterioranterior spine (L14), lateral
spine (L24), total hip, and whole body. While
changesinBMDatthehipandwholebodywere
minimal and not significantly different between
groups, there were differences in the change of
BMD at the spine. The WBV group experienced
significantly greater increases in BMD in
thelateral view of the spine (p= 0.031), which is

supported by a trend for greater increase in the


posterioranterior(PA)view(p=0.079).
Figure2displaysbonemineraldensityat
baselineandafterthe12weekinterventionatthe
lateral view of the spine. Figure 3 presents the
baseline and posttraining BMD values at the
posterioranterior spine. The WBV group
(indicated by the dotted line) experienced an
average increase in BMD of 2.7% in the lateral
view and 1.0% in the posterioranterior view of
the spine. Meanwhile, the control group (solid
line) showed an average decrease of 1.9% at the
lateral spine and 0.9% at the posterioranterior
spine.
Results of the Block Food Frequency
Questionnaire revealed a calcium intake of

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WholeBodyVibrationTrainingisOsteogenicattheSpineinCollegeAgeMenandWomen

1006330 mg per day for the WBV group and


1009298mgperdayforthecontrolgroup(Table
1). Calcium intake measured at the 12week
followup via the LMU RAM was also similar
between groups at 853521 mg per day
consumptionforWBVgroupand943455mgper
dayforthecontrolgroup.

Themenstrualhistoryquestionnairerevealedthat
3 controls and 1 WBV participant were currently
taking oral contraceptives. Of the 13 female
controls, 10 reported eumenorrhea while three
described their menstrual function as
oligomenorrheic (more than 35 days between
cycles).ThreeofthefourfemaleWBVparticipants
experienced eumenorrhea while the remaining
femalereportedtobeamenorrheic.

Figure1
WholeBodyVibrationPlatformandExercises
A. Wholebodyvibrationplatform,participantswereinstructedtoplacetheir
feetatposition2indicatedatthetopandbottomoftheplatform
B. Lungingexerciseonthewholebodyvibrationplatform
C. Pushupholdcompletedwithfeetplacedonwholebodyvibrationplatform
D. Pushupholdcompletedwithhandsplacedonwholebodyvibrationplatform

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byLigouriG.C.etal.

ControlGroup
WBVGroup

Figure2
ChangeinlateralBMDforindividualsinthecontrolgroup(solidlines)
andtheWBVgroup(dottedlines)frombaselinetoposttraining

ControlGroup
WBVGroup

Figure3
ChangeinBMDoftheposteranteriorviewofthespineforindividuals
inthecontrolgroup(solidlines)andtheWBVgroup(dottedlines)
frombaselinetoposttraining

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WholeBodyVibrationTrainingisOsteogenicattheSpineinCollegeAgeMenandWomen

Discussion
The results from this investigation
suggestthatspecific,dynamicexerciseperformed
on a whole body vibration platform may be
osteogenic. We report that a 12week WBV
training program performed 3 days per week
improved BMD at the lateral and posterior
anterior view of the spine. Density changes may
havebeenmoresignificantatthelateralviewdue
to its high content of trabecular bone, which is
particularly responsive to changes in lifestyle
patterns such as increasing weightbearing
activity. Conversely, the posterioranterior view
of the spine contains a higher proportion of
corticalbonemakingupthespinousprocess;this
type of bone is less responsive to rapid change
when compared to trabecular bone. Report of
lateral BMD is not yet commonplace in research
literature and therefore its use in this
investigationisastrengthwhichaddstothebody
of work investigating bone health in response to
exercise. The osteogenic success of this program
after only 12 weeks of training is likely due to
several factors such as the combination of
vibrationanddynamicexercise,theyoungageof
theparticipants,highadherenceofthesupervised
exercise program, lower baseline BMD at the
spine,andanexerciseprogramthatprogressively
increasedintensity.
While previous work has been done on
the effects of WBV, little is known about how
dynamic exercises performed on the vibration
platform can increase bone health and assist in
achieving optimal peak bone mass. This
innovativetrainingprogramcombinesWBVwith
exercises that have already been shown to elicit
improvements in bone density. It is well known
that bone responds to the physical deformation
induced through weightbearing activity by
increasing density (Kohrt et al., 2004). The
increaseinBMDreportedheremaybeduetothe
high level of strain caused by the dynamic
exercisesperformedontheplatform.Maddalozzo
etal.(2007)reportedthat12monthsofsquatand
deadlift exercises improved BMD at the spine in
postmenopausal women by 0.43%. While
Maddalozzoetal.(2007)implementedayearlong
intervention (as compared to 12weeks), this
investigation may have found greater changes
(2.7%advantageovercontrols)inashorterperiod

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of time because the participants were younger


(averageageof19),likelytobebettertrained,and
additionally exposed to WBV during exercise.
Increases in BMD at the spine were expected
because the program specifically incorporated
squatanddeadliftexercises;movementsthathave
been shown to improve BMD at the spine
(Almstedtetal.,2011;Maddalozzoetal.,2007).
A high level of adherence strengthened
the investigation as participants completed an
average of 90% (range 74100%) of the training
program. The previously mentioned work by
Gilsanz et al. (2006) found improvements in
trabecular BMD at the spine and cortical bone
area of the femur after female participants
completed 12 months of WBV for 10 minutes a
day.However,thefindingsofGilsanzetal.(2006)
were affected by a low compliance of 43%, most
likely because the training was unmonitored and
participantswereaskedtocompletethevibration
exposure on their own time, at home. A pilot
investigation by Beck et al. (2006) installed
platforms in the participants homes and
experienced a mean compliance 60%. Even with
compliance at 60%, the12month intervention by
Becketal.(2006)resultedina2%increaseinBMD
at the hip for women of about 38 yearsofage.
The ability to detect improvements after only 12
weeks is likely influenced by the high adherence
ofthissupervisedexerciseprogram.
The DXA bone scan provides a Zscore
which reflects the comparison of a persons bone
mineraldensitytoothersofthesameage,sex,and
ethnicity. Zscores are reported as the number of
standard deviations above (positive values) or
below (negative values) the average density of
similar people. The International Society for
Clinical Densitometry defines a Zscore of less
than 2.0 as below the expected range for age
(Bianchi et al., 2010). At baseline, participants
exhibitednormalBMDvaluesatthehip,reflected
byZscoresclosetotheaverage(0.02forcontrols
and 0.13 for WBV) and therefore likely had no
majorneedforimprovementinBMDatthisbone
site. Furthermore, at baseline, while still
considered normal, participants had lower
BMD at the spine, reflected by Zscores of 0.46
forcontrolsand1.08forWBVvolunteers,which
maybetterexplainthesuccessoftheintervention,
particularly at the spine. Moreover, when
comparingthisinterventiondesigntotheworkof

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byLigouriG.C.etal.

others, ours utilized dynamic exercises that


progressively became more difficult or complex
over the course of the program. Torvinen et al.
(2003)incorporatedsomelightsquatting,jumping
andslightkneeflexionthatincreasedinvibration
frequency, however there were no evident
improvements in the bone health of their young
adultvolunteers(ages1938years)after8months
of WBV training, 35 days per week. A possible
cause for this success is the difficulty of the
dynamic
exercises,
which
progressively
challengedparticipants.
Several researchers have investigated the
potential for WBV to improve bone health for
postmenopausalwomen.BeckandNorling(2010)
reported that 8months of WBV performed 2
times per week helped the postmenopausal
volunteerstomaintainBMDatthetrochanterand
spine while control counterparts experienced a
6% bone loss. In contrast, Bemben et al. (2010)
reportednoskeletalbenefitsto8monthsofWBV
exposure(3daysperweek)incombinationwitha
traditional
resistance
training
program.
Improvements in BMD at the hip were observed
by Gusi et al. (2006) who examined
postmenopausal women also completing 8
monthsofWBV.Ourinvestigationusedasimilar
protocol to Gusi et al. (2006) including
comparable total vibration time per session
(approximately 360 seconds compared to our
rangeof165540seconds),useoftheGalileo2000
platform, which is the European partner of
Vibraflex,andthesimilarhighlevelofadherence
(90%), however unlike Gusi et al. (2006) we did
notfindanystatisticallysignificantimprovements
in BMD at the hip, only the spine. A possible
explanationforthesefindingsatthespinebutnot
at the hip is because participants were young,
healthy and physically active at baseline,
especially in activities that incorporated running.
The WBV participants performed an average of
106.8+69.1 METhours per week of activity while
thecontrolgroupcompleted65.4+49.4METhours
perweek(Table1).Despitethis,physicalactivity
outside of the intervention was not statistically
different between groups, and statistically
controlling for activity did not alter the findings.
Becauserunningisaweightbearingexercise,itis
oftenprotectiveofbonehealthatthehip(Kohrtet
al.,2004).
Intentional pieces of methodology

decreased the opportunity for introducing error.


All DXA scans were performed and analyzed by
one, trained lab technician while all
questionnaires were established as valid for this
population (Block et al., 1990; Henry and
Almstedt, 2009; Pereira et al., 1997). Calcium
intake was measured because of its substantial
potential influence on bone health. Calcium
consumption measured via the Block 2005 Food
Frequency Questionnaire at baseline or via the
LMU RAM at followup was not statistically
different between groups.According to the data
frombaseline,bothgroupswereconsumingmore
calcium(1006330mgforWBVgroupvs.1009
298 mg for the control group, p=0.89) than the
recommendeddailyallowance(RDA)of1000mg
perdaysetbytheInstituteofMedicineforadults
19yearsofageorolder(Medicine,2011).Dietary
intake at followup indicated that both groups
were continuing to consume similar amounts of
calcium, although intake was slightly below the
RDA at this time point (853 521 mg for WBV
group vs. 943 455 mg for control group,
p=0.66).Sincecalciumintakewassimilarbetween
groups and consumption was above national
levels for this age group, it is not likely that
dietary intake of calcium influenced the bone
resultsreportedhere(Alaimoetal.,1994).
Itwasunexpectedtodiscoverthatcontrol
participants experienced a decrease in BMD
duringthe29weeksbetweenDXAscans(1.9%at
thelateralspineand0.9%atthePAspine).These
participants were asked to maintain their normal
dietandexercisepatternsandtheydemonstrated
no significant changes in physical activity (MET
hours per week), dietary intake (mg per day of
calcium), or body mass (kg). While the percent
change could be due to measurement error
associated with the DXA analysis, the
combination of controls experiencing a decrease,
while the WBV demonstrated an increase
suggests the findings are due to the exercise
intervention and not measurement error. With
that said, a decrease in BMD for control
participantswarrantsadditionalinvestigationinto
possiblecausessuchasbingedrinkingorchanges
in the amount of boneloading activity between
highschoolandcollegeyears.
The objective of this investigation was to
evaluatetheosteogenicpotentialofWBVtraining
with dynamic exercise at improving bone health

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WholeBodyVibrationTrainingisOsteogenicattheSpineinCollegeAgeMenandWomen

in young individuals, thereby optimizing peak


bone mass development. Results of this small
investigation of a short duration are promising
and provide justification for further evaluation,
including correction of limitations to this pilot
studysuchasthesmallsamplesizeand12week
interventionperiod.Alongertrainingperiodmay
provide greater power to detect significant
differencesandwouldallowforperiodictracking
ofBMDchanges.Withsofewparticipants,itwas
not possible to effectively evaluate bone
improvements in men and women separately.
Greater knowledge could be gained if this
investigation were to be replicated with a larger
sample size while investigating men and women
separately.

Awholebodyvibrationtrainingprogram
incorporating exercises such as squat, stifflead
deadlift, stationary lunges, pushup hold, bent
over row, and jumps performed 3 days a week,
for 12 weeks, improved spinal BMD in healthy,
collegeaged men and women. The program,
which ranged in vibration frequency from 1526
Hz, requiring 2030 min per workout, elicited a
positivechangeinvertebralbonemineraldensity.
By increasing BMD in young adults, peak bone
mass can be optimized and future risk for
osteoporosis may be diminished. Further
longitudinal investigation with a larger sample
size is needed to assess the longterm effects of
WBV training on the deterrence of osteoporosis.

Acknowledgements
We would like to express our sincere appreciation to every member of the 20092010 Loyola Marymount
UniversityHumanPerformanceLabteam,includingMarshallSpiegelandMatthewStapleton,fortheirhelp
intrainingparticipants,ToniShorma,MariaFrye,andJenniLowforassistanceindatacollection,analysis
andmanagement.WewouldalsoliketogratefullyacknowledgeScottGuererro,HeadCoachoftheLoyola
MarymountUniversityCrossCountryTeam;LoyolaMarymountUniversitySeaverCollegeofScienceand
Engineering;andSigmaXiScientificResearchSocietyfortheirsupportofthisresearchproject.Wearemuch
appreciativeofProfessorDavidRamirezforhisassistanceinsecuringalocationfortheexerciseintervention
totakeplace.Lastly,thankyoutoDr.RobertRovettiforlendinghisexpertiseinresearchdesignanddata
analysis.

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CorrespondingAuthor
HawleyC.AlmstedtAssociateProfessor
DepartmentofHealthandHumanSciences,LoyolaMarymountUniversity
1LMUDriveMS8160,LosAngeles,CA90045
Phone:3103381925(phone)
Fax:3103385317(FAX)
Email:Hawley.almstedt@lmu.edu

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